Attenborough backs calls for a halt to mining the deep sea for minerals used in smartphones and electric car batteries - saying it has a 'huge impact' on wildlife and climate change

Conservationists warn deep sea mining will cause a range of serious problems

Sir David says mining the sea bed without understanding it is 'beyond reason'

Experts warn mining the sea bed could cause the destruction of ecosystems

Run off from sediment creating through mining could smother areas and kill fish

By RYAN MORRISON FOR MAILONLINE 24 March 2020

Sir David Attenborough has backed a call for deep sea mining to be stopped as conservationists warn it could have a 'huge impact' on wildlife and the climate.

A report by Fauna and Flora International (FFI) calls for a moratorium on moves to mine the deep sea for minerals used in mobile phones and electric car batteries.

The conservation organisation says deep sea mining could see entire ecosystems of species never studied and barely understood disrupted and destroyed.

The process could also create large plumes of sediments that smother areas far away from the mining sites themselves and kill marine life, FFI claims.

'The rush to mine this pristine and unexplored environment risks creating terrible impacts that cannot be reversed,' said Sir David, vice president of FFI.

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Sir David Attenborough is backing a call for a moratorium on deep sea mining. He says mining the surface without fully exploring it is 'beyond reason'


This image of a tripod fish is among the species that could be harmed through deep sea mining if it is allowed to continue, says Sir David Attenborough

FFI said in their report toxic and heavy metals could be released and spread dangerous toxins to areas of the oceans that are important for fisheries.

Mining could also lead to the loss of microbes that capture methane and carbon and disrupt the oceans 'biological pump' which takes carbon from the atmosphere and transports energy and nutrients through the oceans, the team warn.

'Mining the deep sea could create a devastating series of impacts that threaten the processes that are critical to the health and function of our oceans,' said Sir David.

'Fauna & Flora International is calling on global governments to put in place a moratorium on all deep sea mining – a call I wholeheartedly support.'

The wildlife presenter said the idea that people should be considering the destruction of deep sea places before they have understood them or the role they play in the health of the planet 'is beyond reason'.

'We need to be guided by science when faced with decisions of such great environmental consequence.'

Exploratory deep sea mining is already under way, but mining on a large scale is on hold until nations have agreed the rules covering it, which are being developed under the UN International Seabed Authority with efforts to finalise them in 2020.

FFI warned that human activity was already putting a huge strain on the oceans.

They have already absorbed a third of our carbon emissions and 93 per cent of the extra heat trapped by greenhouse gases, FFI said.

Oceans are becoming more acidic because of the carbon dioxide dissolving into them, fisheries are under pressure as a result of over-exploitation and there are hundreds of huge 'dead-zones'.


This rare deep-sea cirrate octopod is among the ocean species that are being studied by scientists. Sir David Attenborough says the rush to mine this pristine and unexplored environment risks creating terrible impacts that cannot be reversed


Whole ecosystems including octopus and sea sponges could be destroyed if mining is allowed to continue, according to Flora and Forna International

'Minerals on the seabed are centre-pieces of deep sea ecosystems. Plans to mine the deep sea must be put on hold,' said Pippa Howard, director at FFI.

'From methane release to disruption of the ocean's life-support systems and the destruction of unstudied ecosystems, the risks of deep sea mining are numerous and potentially disastrous,' she said.

'To place the ocean under the additional stresses that would be created by deep sea mining would be rolling the dice with the functioning of key planet-wide processes. We take this step at our peril.'

A Government spokesman said the UK is pushing for the highest international environmental standards including on deep sea mineral extraction.

'While we have sponsored two exploration licences, these allow only for marine research to understand the effects of deep sea mining,' he said.

'We will not issue a single exploitation licence without a full assessment of the environmental impact.'

Producing energy from wind or solar is now CHEAPER than coal as campaigners demand power stations are shut down

It could be cheaper to build renewables than run coal in major markets by 2030

Green alternatives including solar and wind are cheaper in more than 30 nations 

Governments must block new coal power projects or waste $600bn, report says

By JONATHAN CHADWICK FOR MAILONLINE UPDATED: 24 March 2020

Burning coal as a power source wastes hundreds of billions of pounds because environmentally friendly renewables are a much cheaper option, says a new report.

In big energy markets such as the UK, the US and Australia, it costs less to generate power from installing wind or solar farms than coal plants, Carbon Tracker says.

Globally around 60 per cent of existing coal plants are generating electricity at a higher cost than building and running new renewable schemes, the think tank says.

It could be cheaper to generate electricity by building new renewable facilities than running existing coal power stations in all markets by 2030, it also predicts.

Policymakers should stop new coal investments and revamp power market regulation, it writes in its new report, titled ‘How to waste over half a trillion dollars’.


A coal fired power plant. New investments in renewables are cheaper than new investments coal in all major markets today, says think tank Carbon Tracker

'Renewables are out-competing coal around the world and proposed coal investments risk becoming stranded assets which could lock in high-cost coal power for decades,' said Matt Gray, Carbon Tracker co-head of power and utilities and co-author of the report.

'The market is driving the low-carbon energy transition, but governments aren't listening.

'It makes economic sense for governments to cancel new coal projects immediately and progressively phase out existing plants.'

'Investors should be wary of relying on continued government support for coal when a phase-out will save their voters billions and make their economies more competitive,' said Sriya Sundaresan, Carbon Tracker senior analyst and co-author of the report.

The organisation lists more than 30 nations where new investments in renewables are cheaper than new coal investments, including 20 EU countries, the UK, the US, Australia, India, China, Russia and South Africa.

In the UK alone, 82 per cent of the UK's remaining 12 gigawatt of operating coal power costs more than new renewables, Carbon Tracker said.

In the UK, falling coal demand, subsidies for renewables and a government initiative to reduce coal investment – called Carbon Price Floor – has helped push most coal off the system ahead of a phase-out date, recently moved forward to October 2024.

Britain's reliance on coal for electricity has dropped from 70 per cent in 1990 to less than 3 per cent today, the government says, and coal-generated energy will soon be a 'distant memory', according to Business and Energy Secretary Andrea Leadsom.

Carbon Tracker is now urging governments and investors to cancel the vast amount of coal projects announced, permitted or under construction around the world – or waste £638 billion (£495 billion) in capital investment. 

Didcot chimney is demolished after 50 years at power station

The cooling towers at the disused coal-fired Didcot power station in Oxfordshire as they're demolished, August 18, 2019. The deadline for the phase-out of coal from Britain’s energy system has recently been brought forward a year to October 1, 2024


The cooling towers at the disused coal-fired Didcot power station in Oxfordshire as they're demolished, August 18, 2019. The deadline for the phase-out of coal from Britain’s energy system has recently been brought forward a year to October 1, 2024 +3 The cooling towers at the disused coal-fired Didcot power station in Oxfordshire as they're demolished, August 18, 2019. The deadline for the phase-out of coal from Britain’s energy system has recently been brought forward a year to October 1, 2024 Almost 500 gigawatts of new coal power is planned or under construction, but Carbon Tracker warns governments and investors may never recoup their outlay. 

Almost 500 gigawatts of new coal power is planned or under construction, but Carbon Tracker warns governments and investors may never recoup their outlay.

POPULAR RENEWABLE ENERGY SOURCES


Solar - light and heat from the sun.

Wind - through wind turbines to turn electric generators.

Hydro - captured from falling or fast-running water.

Tidal - energy from the rise and fall of sea levels.

Geothermal - energy generated and stored in the Earth.

Biomass - organic material burnt to release stored energy from the sun.

Source: EDF Energy

Falling costs of wind and solar power and the investment needed comply with existing carbon and air pollution rules mean coal is no longer the cheapest form of power in any major market.

In the EU, which has a strong price on carbon pollution and years of investment in renewables, almost all (96 per cent) of its operating coal capacity costs more to run than new renewables.

And in China, which is home to half the word's coal generation, seven out of 10 plants already operating cost more to run than building new solar and wind farms.

The report warned that China, whose economy has been hit hard by coronavirus, must avoid costly coal power in any economic stimulus package the government implements in the wake of the outbreak.

In the face of suggestions China is planning to approve new coal plants in the near future, Carbon Tracker urged the country to deploy its stimulus capital 'efficiently and avoid investing in coal power which is economically redundant and environmentally disastrous'.

Emissions have fallen in the UK in part due to a switch to renewables and a huge decrease in the burning of coal

Limiting global warming to 2.7°F (1.5C) by the end of this century, to avoid the worst impacts of climate change, means global coal use to generate electricity will have to fall by 80 per cent from 2010 to 2030.

To hit this target, as stipulated in the UN Paris Agreement in 2015, effectively one coal plant has to retire every day until 2040, the report said.

A previous report found that UK carbon dioxide emissions have fallen to levels not seen since the 19th century during the reign of Queen Victoria, due to a reduction on the reliance of coal to generate power.

Climate website Carbon Brief said carbon emissions from coal have fallen 80 per cent over the past decade.

REGIONS WHERE NEW RENEWABLE ENERGY IS CHEAPER THAN COAL

Austria

Bulgaria

Croatia

Czech Republic

Denmark

Finland

France

Germany

Greece

Hungary

Ireland

Italy

Netherlands

Poland

Portugal

Romania

Slovakia

Slovenia

United Kingdom

Spain

Sweden

USA

Russia

Turkey

Vietnam

South Korea

Japan

Philippines

Australia

Malaysia

India

Indonesia

South Africa

Bangladesh

Pakistan

Source: Carbon Tracker

Read more:
How to waste over half a trillion dollars: The economic implications of deflationary renewable energy for coal power investments - Carbon Tracker Initiative

Rare orchids and wildflowers are increasingly flourishing in the UK as global warming pushes them north

Rare orchids such as the Bee orchid are being found in Scotland for the first time

The southern marsh-orchid has spread its habitat as far north as Newcastle

The results come from the first five years of a national citizen-led plant survey

By RYAN MORRISON FOR MAILONLINE 25 March 2020

Wildflowers and rare orchids like the Bee orchid are moving further north in the UK as as temperatures rise, a citizens survey found.

The discovery has prompted calls to manage landscapes to make space for a wider variety of plants in the face of climate change.

Results from the first five years of the government-funded National Plant Monitoring Scheme already shows the impact of a warming world on the UK's plants.

Southern marsh-orchids, a tall plant found in damp grasslands, was once restricted to southern UK but records have come in from as far north as Newcastle upon Tyne.


The survey uses data from 15,000 surveys by volunteer citizen scientists and already shows wild orchids expanding their range to areas they have never been in before.


Southern marsh-orchids, a tall plant found in damp grasslands, was once restricted to southern UK but records have come in from as far north as Newcastle upon Tyne

The National Plant Monitoring Scheme looks at 30 different habitats, from woodland and hedgerows to blanket bogs and streams, with around 30 wild flowers to search for in each type of place.

Data is collected by volunteers, co-ordinated by wildlife charity Plantlife and analysed by botanists from a range of organisations .

Bee orchids were not previously found in Scotland, but volunteers have discovered the plants, whose flowers resemble a bee's backside, at several sites around Glasgow and Edinburgh, according to Plantlife.

Other specialist plants are moving outside their usual range, including mossy stonecrop, a succulent once only found in the New Forest and East Anglia.

This has also started to spread to sandy habitats in Scotland.

Early meadow-grass was formerly only found on the Lizard Peninsula in the extreme South West of England but has now been recorded in Fishguard, south-west Wales.

In fact it has spread even further, volunteers spotted the grass in Rosslare in Ireland, and central London.

While southern plants are finding new habitats in cooling northern climates, there is a concern for northern plants that have nowhere else to go, said Plantlife.

This includes Arctic and alpine species which cannot go further up the mountains, such as Highland saxifrage.

The increased risk of drought due to climate change puts many smaller, short-lived species at risk, with fairy flax, yellow-wort, soft brome and common mouse-ear suffering from heat and lack of water in 2018's drought.

However, while some species will die out due to a lack of water, the results from the monitoring scheme also show a rise in species able to cope with drought.

These include salad burnet, a dark crimson flower found in old hay meadows, which has a longer root so it can reach down to moist soil, and wild thyme, which managed water loss with its tiny leaves.

Bee orchids were not previously found in Scotland, but volunteers have discovered the plants, whose flowers resemble a bee's backside, at several sites around Glasgow and Edinburgh, according to Plantlife

The analysis also reveals the impact of nitrogen pollution, with nitrogen-hungry stinging nettles the most frequently recorded native species in woodlands.

Dr Trevor Dines, Plantlife's botanical specialist, said experts had previously thought that it would 'take an awful lot' for plants to start moving northwards.

He said this is because the dispersal of plants is very slow.

'To actually start seeing that now, coming through so strongly, is a real wake-up call,' he said, adding, 'it proves to us that climate change is having a real impact.'

'Our concern is that we live in such a fragmented landscape, there aren't the places for these plants to go,' he said.

Growing chances of drought, particularly in the crucial spring months of April, May and June, is even more of a risk than general warmer conditions, Dines warned.

'Any climate change that involves drought scenarios is going to affect plant populations much more quickly.'

He said tackling climate change is about making the landscape as permeable as possible so things can move around.

This can be done by creating habitat where flowers can bloom and setting as much seed as possible through grazing animals and hay cutting at the right time of year.

Road verges, which are corridors through the landscape, should not be subject to repeated mowing, while moving livestock, machinery and distributing wildflower-rich hay can all move seed around the landscape, he said.

While rewilding can play a part on a small scale, Dr Dines said agri-environment schemes could be used to get habitat management in place to suit wildflowers on as wide a scale as possible.

USA
Doctors and nurses on their risks, fears — and hard decisions — in coronavirus pandemic


Caitlin Dickson Reporter,Yahoo News•March 25, 2020494 Comments

Life in the United States and around the world has effectively been put on hold as social distancing has become the strategy of choice against the spread of the coronavirus, which as of Wednesday morning had infected 55,238 and killed 802 in the U.S. Millions are working from home or are out of work entirely, while schools in much of the country are closed.

While the general public is being strongly advised to stay indoors, doctors, nurses and other health care providers can’t work from home. They are facing a new reality of their own, as hospitals and clinics prepare for an imminent influx of coronavirus patients.

This is the second in a series of interviews by Yahoo News with health care providers in different parts of the country. This installment looks at the ways the coronavirus pandemic is reaching beyond emergency rooms and frontline medical workers to affect other parts of the health care system. All the providers who spoke to Yahoo News asked that their names and hospitals not be disclosed, because they were not authorized by their employers to speak to the press.
‘We’re forced to go into a situation that we’re recommending the rest of the world not to be in.’

Many hospitals around the country have begun canceling elective procedures in order to free up bed space, equipment and personnel to make room for more likely coronavirus patients. But one surgeon at a large California hospital pointed out that the kinds of procedures that require intensive care are rarely elective, and those can’t simply be canceled even amid a pandemic. The surgeon was not authorized to speak to the press, and asked that his identity, including his specialty, not be disclosed out of concern for his job. However, the types of surgeries he performs are typically emergent, with at least 50 percent or more of his patients requiring recovery time in the intensive care unit, he said.

“You hear on the news that we’re gonna free up all these ICU beds, but that’s really hard to do,” he said. “In an ideal world, we wouldn’t do surgery anymore.” However, there are still “people who don’t have coronavirus [who are] dealing with issues that are life-threatening,” he said, noting that patients continue to be admitted into the ICU with heart failure, strokes and sepsis, among other urgent conditions.

“We can’t say we’re not going to do your surgery because of the potential need [for future coronavirus patients], but every time you do that you’re limiting the number of beds that will be available next week.”

So far the surgeon said he has not been in the position of having to deny a patient a lifesaving procedure to make room for a coronavirus patient, but he worries about that possibility as the number of cases continues to grow. As of Wednesday morning, data from Johns Hopkins University showed that there were 2,628 confirmed cases of the coronavirus in California, including 54 fatalities.

“Eventually, we’ve been told, there’s not going to be enough ventilators and ICU beds, but those beds don’t just appear, right?”

A nurse at MedStar St. Mary’s Hospital in Leonardtown, Md., works outside a patient’s room in the intensive care unit Tuesday. Hospitals around the United States are continuing to prepare for an expected onslaught of cases related to COVID-19 in the days ahead. (Win McNamee/Getty Images)

Even as the hospital takes steps to prepare for an impending surge in coronavirus patients, the surgeon expressed shock and concern over what he described as inconsistency between the social distancing measures prescribed for the general public and what is being practiced by health care providers and other hospital staff.

“In the outside world, we’re told to stay 6 feet away from each other and not interact. Then you walk around the hospital and people are having lunch together. You walk into a resident workroom and six people are working on computers, [none of them] wearing masks.

“I don’t know if people have a false sense of security because [they’re] not in the real world, but we know of patients who are asymptomatic,” he said. “In my mind, I think every time you go into a new room you should put on a new mask, but people aren’t doing that.”

The surgeon described what he’s observed as “two worlds” within the hospital: one where certain nurses and doctors, especially anesthesiologists and emergency room personnel, appear to be “wearing masks all day,” and another in which no one is wearing a mask, including housekeeping and cafeteria workers.

CDC recommendations regarding who needs to wear a mask and when continue to evolve along with the coronavirus pandemic — largely shifting in response to supply shortages created by increased demand.

While the surgeon acknowledged that “we don’t have enough resources to treat every single patient like they have the disease,” he worries that failure to take sufficient precautions could result in significant spread of the coronavirus among health care workers.

“We’re screwed,” he said. “We’re forced to go into a situation that we’re recommending the rest of the world not to be in.”

Like other doctors, he worries less about how his own exposure could impact members of his family.

“I don’t let my kids in my own car anymore because I’m worried my car has germs in there,” he said. “It’s impossible not to be exposed to someone sick in the hospital.”

Henry Ford Hospital in Detroit, pictured on March 16. U.S. hospitals are setting up triage tents, calling doctors out of retirement, guarding their supplies of face masks and making plans to cancel elective surgery as they brace for an onslaught of COVID-19 patients. (Paul Sancya/AP)

‘If people were to take us as leaders or examples for how to act in this situation, we’re doing a horrible job.’

The surgeon in California is not the only one noticing a disparity between the way health care workers are interacting as opposed to the rest of the public.

“In my personal life, I feel like everyone is isolating, social distancing,” said a nurse in the NICU, the neonatal intensive care unit, at a large hospital in the Midwest. But in the hospital, she said, health care workers are still clustered in halls and eating in communal break rooms, touching elevator buttons and opening doors.

“It feels really hypocritical to be a health care provider and encouraging other people to not do everything that we do as soon as we walk through the doors, said the nurse, who also asked that her name and hospital not be disclosed because she was not authorized to speak to the press. “If people were to take us as leaders or examples for how to act in this situation, we’re doing a horrible job.”

“I was literally dreading going to work because of how much more at risk I felt than in day-to-day life at home,” she said. Even her own efforts to regularly disinfect her personal workspace and any surfaces touched by her patients feel inefficient and wasteful.

“It’s a lot of cleaning up after myself and other people over and over again. That’s not what you should be doing when trying to provide patient care,” she said.

As an NICU nurse, she is not directly treating confirmed or suspected coronavirus patients, but she is being trained to respond to a new patient population emerging from the pandemic: pregnant women who’ve tested positive for COVID-19.

A minimum of three health care providers from the NICU — a nurse, a doctor and a respiratory therapist — are required to attend all high-risk deliveries. Those include cases of fetal distress (such as low heart rate) and any delivery by a mother before her 37th week. Now, she said, deliveries involving a coronavirus-positive mother are also considered high risk.

A midwife shows a newborn to medical workers after a Cesarean section delivery on a suspected COVID-19 patient in Wuhan Union Hospital in Wuhan in central China’s Hubei province on March 7. The hospital’s ob-gyn department has been designated to take care of women with the coronavirus disease since the outbreak. (Feature China/Barcroft Media via Getty Images)More

Between the labor and delivery team and the NICU team, she said there can be up to 20 people present for a high-risk delivery. If the mother has tested positive for the coronavirus, all those people have to be wearing personal protective equipment, which they must each put on according to protocol in a negative pressure isolation room, known as an anteroom, before they enter the delivery room.

Under new visitor restrictions adopted by many hospitals, mothers who haven’t tested positive for the coronavirus are now allowed only one visitor in the delivery room. For those who have been infected with the virus, she said, “I don’t know if those moms are allowed [to have] anyone ... which is so sad. I can’t imagine being a laboring mom alone, with no one in there with you.”

The nurse who spoke to Yahoo News said that her hospital has established a sort of “makeshift COVID labor and delivery floor” with a handful of rooms designated for mothers with the coronavirus to give birth. They’ve started setting up carts of protective equipment outside those rooms; however, at this point only one of them is equipped with a proper anteroom.

“The rest are just regular rooms where we’re saying, ‘Never mind, it’s OK not to have an anteroom. Just put on the PPE outside the door and hope for the best,’” she said, adding that part of her training for this new type of delivery included instructions to “open the door as little as you need to in order to shimmy in and out.”

As with any high-risk delivery, the NICU team’s role is to determine whether the baby appears well enough to go to the regular postpartum floor or if the baby is in distress and needs to be taken to the NICU. For babies born to mothers with COVID-19, she said, the assumption is that the newborn is also positive for the virus, and those that are “well-appearing” upon delivery must be taken to an isolation room on the postpartum floor.

A medical staff member attends to a baby with the coronavirus at the Wuhan Children’s Hospital, in Wuhan, China, on March 6. (China Daily via Reuters)

For all the training she’s received on how to handle these new types of deliveries, the nurse said there are still a lot of unanswered questions. Based on what she was told, she said that mothers who’ve tested positive for the coronavirus must remain separated from their baby as long as they’re in the hospital, which, she said, “has a lot of consequences for mental health, feeding, production of breast milk.” But it’s not clear whether, if the baby is ready to be discharged before the mother, who will be able to take the baby home, as the father or partner is also presumed to have been exposed to the coronavirus if they and the mother live together.

“It’s these horrible, heartbreaking situations where we’re talking about finding another family support person to come pick up the baby,” she said.

The NICU nurse said that so far she hasn’t participated in any coronavirus deliveries yet but is already aware of at least one pregnant patient who has tested positive. “It’s very much not a matter of if, just when” it will happen, she said. She worries about how the elaborate, time-consuming process of putting on and removing personal protective equipment and carefully entering and exiting the makeshift COVID delivery rooms will play out in a real-life emergency situation.

“We’re a very well oiled machine, so it’s a very anxious feeling to have so many unknowns in how to provide safe, effective care for people,” she said. “This just feels like chaos.”
‘Every day I go into work thinking, “I don’t want to be that Kirkland nursing home.” That would be the worst-case scenario.’

The impacts of the coronavirus on the health care system stretch beyond the different units of a hospital. The medical director of one mid-Atlantic residential addiction treatment facility told Yahoo News: “Every day I go into work thinking, ‘I don’t want to be that Kirkland nursing home.’ That would be the worst-case scenario.”

The medical director asked that his name and the location of the facility (which includes the state in its name) not be mentioned because it is part of a small addiction treatment community that could easily be traced back to him. But the facility is located in a state that, as of Wednesday morning, had fewer than 400 confirmed cases of the coronavirus.

“We’re not a hospital per se, but we’re a health care facility,” he said, explaining that, unlike at a hospital, the facility’s staff doesn’t have the kind of universal training in infection control practices.

“We give medications and things like that, but we’re not doing very high-level medical care,” he said. “The premise is, if you’re sick you get sent out.”

“Now if you have somebody who has a fever, it’s a major issue,” he said.

The average length of stay at this facility is between 20 and 30 days. They don’t take Medicare or Medicaid, and about 85 percent are covered by private insurance. There are approximately 70 patients and 30 or so staff, he said, so there are about 100 people in the building at a given moment, and it’s a “relatively small space.”

“Up until last week we had a cafeteria in which 50 people easily would be eating, sitting, more or less right next to each other,” he said. The patients would “go from there to various groups with 20-30 patients in a small room.”

Even though patients have TVs in their rooms and have been watching the news about the coronavirus spreading over the past few weeks, the medical director said, “For the longest time I was kind of surprised there wasn’t a whole lot of uproar among patients and staff, up until last week. This last week sort of hit home for a lot of people, I think.”

Several people actually signed out of the facility after a rumor started circulating that the governor was going to enact a shelter-in-place order preventing them from leaving.

“It was a false rumor, but [it was] the kind of thing that has thrown everything up in air,” he said. Since then, the facility has made a variety of changes, including allowing only 10 people to eat in the cafeteria at a time. It has also started working on transitioning some group therapy to a virtual conferencing platform instead of in-person meetings.

Though he said employees are not supposed to come to work if they have any symptoms, there’s been a sense of panic among some of the staff.

“Several staff members who are not young and have chronic medical conditions, asthma, etc., are appropriately concerned about walking around a building with 100 people in petty close proximity,” he said.

A doctor walks outside the Life Care Center of Kirkland, a long-term care facility linked to several confirmed coronavirus cases, in Kirkland, Wash., on March 5. (Lindsey Wasson/Reuters/File Photo)

While he believes the treatment facility should follow the CDC’s recommendation that anyone confirmed or suspected to have the coronavirus who does not need to be hospitalized should self-quarantine at home, he also noted that determining whether to send a sick patient home from the facility he runs presents a uniquely difficult dilemma.

“One thing we always keep in mind is every decision we make is based on the safety of the patients,” he said. “But in our particular case, a lot of the time people are not safe if they’re not in treatment.”

“If you have an alcoholic with liver disease, which is a frequent type of patient, [and] they go home and start drinking again, they are going to die from alcohol,” he explained. “In the case of patients who’ve been discharged from hospital [who are] still kind of semi-sick, we’ll take them back because the alternative is worse.”

For example, he said a patient was recently sent to the hospital because he was sick, and while he was there, it was discovered that this patient, who is already in the late stages of alcoholic liver disease, is also diabetic.

“He could’ve been admitted, and I think should've been admitted, [but] because of the COVID thing, I think there were not as many beds. [The hospital was] pushing to discharge him,” he said. “I had a choice of saying he’s too medically unstable to come back to us, but in that case he would go home and very likely drink again and become much sicker faster.” He decided to take the patient back to the treatment facility, even though he wasn’t fully medically stable.

The medical director said he’s often put in this type of position in his job. “The only thing that changes it with COVID is, you’re risking other patients’ safety by keeping them there.”

“Ethically, I have a responsibility to my staff and the other patients to keep them as safe as I can, and we also have responsibility to patients who may have COVID,” he said. “There’s a competing ethic there, where that person may be safer in our facility by not drinking or drugging, but they may also [be] causing significant risk to patients and staff.”

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THE IMPERIAL PRESIDENCY

White House abruptly transfers DHS official amid loyalty purge


By Daniel Lippman POLITCO 3/25/2020

The White House removed a top public affairs official at the Department of Homeland Security in a move that shocked many in the department as it takes a lead role in handling the coronavirus pandemic, according to two former senior DHS officials familiar with the matter.  

© Win McNamee/Getty Images The Department of Homeland Security main office in Washington.

Heather Swift, who was DHS’s deputy assistant secretary of public affairs, was abruptly pushed out of her position on Friday after the Presidential Personnel Office raised questions about her loyalty to President Donald Trump, said one of the former DHS officials.


The personnel office may have discovered some old social media postings that officials there did not like, this person said, though POLITICO was unable to find any examples of posts the Trump administration might find objectionable.

Swift, who has not yet left the department, is moving to a top communications job at the National Endowment for the Arts, a detour well outside the administration’s power corridors.

The transfer represents a fresh blow to Swift’s career aspirations: Several months ago, after serving for a few months in an acting capacity as the top public affairs official at DHS, she angled for that job permanently -- only to be disappointed when she was not promoted, according to a Trump administration official. The position instead went to Dirk Vande Beek, a veteran communications strategist who came from the Department of Energy and also worked on the 2000 Bush-Cheney campaign. (AND WHO IS MALE)

Since taking over PPO, 29-year-old John McEntee has asked Cabinet agencies to probe the records of political appointees and ferret out any who might show signs of disloyalty to the president. McEntee, a former college quarterback known for his trick plays and a longtime Trump favorite, has also come under fire within the administration for recently hiring three college seniors for sensitive jobs.

One former official pushed back hard on the notion that Swift had been anti-Trump in any way and called her a Trump “acolyte” who “loves the president” and did not want to leave the department. Swift has been a good team player, was well-liked by her staff and colleagues and has worked hard to achieve the department’s mission, this person said.

Swift and DHS did not provide a comment for this story, and a White House spokesperson declined to address Swift’s transfer, citing a policy of not commenting on internal personnel matters.

Swift has been in the Trump administration since early 2017, having joined as press secretary for former Interior Secretary Ryan Zinke before becoming senior adviser at the department. Zinke resigned in December 2018 after several probes into whether he used his position for personal gain, however, and Swift subsequently moved to DHS last August.

Previously, she had worked as Zinke’s communications director when he was in Congress. She also worked on other Republican campaigns, including a short stint as press secretary for Tommy Thompson during his unsuccessful bid for a U.S. Senate seat in 2012.

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Bolsonaro calls Brazilian cities' coronavirus lockdowns a 'crime'

https://plawiuk.blogspot.com/2020/03/mutual-aid-solidarity-and-humor-in.html

 MARCH 25: Brazilian President Jair Bolsonaro gestures during a press conference amidst the coronavirus (COVID - 19) pandemic at the Palacio do Alvorada on March, 25, 2020 in Brasilia, Brazil. Bolsonaro recently defended the nation's return to normality and the end of social distancing and quarantine. According to the Ministry of health, as today, Brazil has 2271 confirmed cases infected with the coronavirus (COVID-19) and at least 47 recorded deceases.(Photo by Andressa Anholete / Getty Images)

Brazil’s president, Jair Bolsonaro, said local leaders who were locking down cities amid the coronavirus outbreak were committing a “crime.”

Latin America’s largest nation has reported 2,433 cases and 57 deaths, and public health experts have warned the outbreak could trigger a collapse of the health care system in a month.

“Other viruses have killed many more than this one and there wasn’t all this commotion,” Bolsonaro, departing from the advice of his own Health Ministry, told reporters outside his official residence, according to Reuters. “What a few mayors and governors are doing is a crime. They’re destroying Brazil.”

“If we don’t get back to work, Brazil could depart from democratic normalcy,” citing examples of social unrest across Latin America.

Meanwhile, Brazil’s national security adviser, Augusto Heleno, on Wednesday cut his medically advised quarantine short, returning to work just seven days into a 14-day quarantine after a positive coronavirus test. Heleno also attended cabinet meetings on the day of his test, Reuters reported.

DRIVER FOR BRAZIL'S BOLSONARO HOSPITALIZED WITH RESPIRATORY ILLNESS AS CORONAVIRUS PROTESTS CONTINUE

At least 23 in Bolsonaro's circle, including his U.S. ambassador, chief foreign policy adviser and communications chief, have contracted the virus

On Tuesday the conservative president also played down the threat of the virus, in a contentious national address he told Brazilians: “90 percent of us will have no symptoms if contaminated.” He added that his “history as an athlete” meant he would suffer from no more than “a little flu” if infected.

Senate President Davi Alcolumbre called Bolsonaro’s speech “grave” and warned that it went against the advice of the World Health Organization. He called for “leadership that is serious, responsible and committed to the life and health of its people.”

Both Sao Paulo and Rio de Janeiro, Brazil’s most populous and most affected states, have begun shutting down non-essential business and public gatherings to slow the spread of the virus.

Both the electricity sector and the agriculture sector said they were suffering due to the coronavirus. Still, the Economy Ministry has said it would not take on long-term debt in order to rescue the economy. A top official said that there was no capacity for huge fiscal packages to fight coronavirus.

Even gangs in Brazil have stepped up to stop the spread of coronavirus, imposing curfews. Gangs in Brazil's poorest neighborhoods, favelas, have imposed curfews. In Cidade de Deus (City of God), gangs have stepped up curfew enforcement after the first coronavirus case was reported.

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Defense industry to make coronavirus masks, ventilators — but will it be fast enough?


By Tara Copp and Michael Wilner, McClatchy Washington Bureau 3/35/2020

WASHINGTON — The Defense Department has begun signing contracts with defense firms to ramp up production of ventilators and N95 respirator masks in short supply around the country, but the medical equipment may not reach hospitals before coronavirus cases peak in the next few weeks, the Pentagon’s head of acquisition said.

© Irfan Khan/Los Angeles Times/TNS Teresa Olivas prepares single face mask bags at Prep and Save store in Upland, Calif. on March 17, 2020. Customers scared of lockdown due to coronavirus cleaned out shelves carrying survival food, hand sanitizer and masks.

“We will strive to do everything we can before June, but we have no data to address that now,” Under Secretary of Defense for Acquisition and Sustainment Ellen Lord said Tuesday at a media briefing at the Pentagon.


The hastened production is being managed under the Defense Production Act, a law that gives the president authority to protect critical national defense supplies by allowing him to prioritize contracts or provide loans, grants or other economic incentives to accelerate their production.

Through the DPA, the Department of Health and Human Services and the Federal Emergency Management Agency will identify what items are needed and then the Defense Department, through its vast connections with defense industries, will place and manage orders.

But only a few contracts have been executed so far.


(Pictured) A worker wearing protective suit looks at signs partially covered in foam while cleaning and disinfecting an underpass to prevent the spread of coronavirus disease in downtown Budapest, Hungary on March 26.Gallery by photo services

Over the weekend, HHS signed a contract with five firms to produce N95 respirator masks, and the Defense Department, under its DPA authority, will now work with those vendors to be able to produce the masks quickly and in large quantities, Pentagon spokesman Air Force Lt. Col. Mike Andrews said.

Asked why the ramp-up for mask production was so late in coming, when the Pentagon had known about the severity of the pandemic for weeks, Lord said the Pentagon had not yet been directed by HHS or FEMA on what were the specific needs.

“They have to give us the demand signal,” Lord said. “Once we get clarity on the demand signal we’ll execute. If you’ll recall, FEMA just got the lead role on Friday.”

“This is all very new,” she said. “I know COVID has been here for several weeks, but this coordination at this level of detail just started on Friday.”

Likewise, the military’s top medic was questioned Tuesday as to why the Defense Department had not obtained more machines to process test kits for deployed forces and get a better picture of the virus’s spread among the military. Although the overall numbers among the 1.3 million active duty are still small, they are quickly climbing, from 49 coronavirus cases on March 18, to 227 on Wednesday.

It will be weeks to months before the machines will be available, said Air Force Brig. Gen. Paul Friedrichs, surgeon general for the Joint Chiefs of Staff.

“We’d love to have had it in January, but we didn’t know the virus was going to be this big of an issue in January,” Friedrichs said.

There were seemingly mixed messages coming from the White House earlier this week on whether the Defense Production Act had been used. President Donald Trump on Tuesday said he had not used it to compel increased production from private manufacturers, who he said are rising to the occasion on their own.

“This morning, Ford, 3M, and General Electric Healthcare are making tremendous numbers — they’ve already started — of respirators ventilators and face shields,” Trump told reporters. “They’re working together. We didn’t have to exercise or utilize the DPA in any way. The fact that we have it helps, but we didn’t have to. And for the most part, we won’t have to.”

Lord said it was possible the White House was talking about the broader use of the Act, not the provisions the Pentagon, FEMA and HHS were utilizing to address coronavirus medical supplies. “I think he is talking about broadly using DPA to, in fact, take over private industry. That’s what he has clearly said he is not going to do,” she said. “The White House is very judiciously looking through what segments of DPA they will use.”

Vice President Mike Pence also said the law had been invoked last week, and that FEMA had provided more than 8 million N95 masks and 14 million surgical masks as of Tuesday.

“The president did initiate the Defense Production Act last week, but as the president has reflected many times, we will use the Defense Production Act if we need it to mandate production of — of critical supplies,” Pence said Tuesday. “But so far, no one has said no.”

Trump said Saturday that he had invoked the DPA to provide his administration with “powerful new authorities to help states, cities, and hospitals procure needed supplies.” He also said Tuesday he had invoked the act as legal justification for an executive order prohibiting the hoarding of personal protective equipment.

The administration has come under criticism in recent days for not using the powers of the DPA, now being utilized by the Pentagon, to ramp up production of critical medical supplies.

“Their answer is, we don’t need to do it because companies are coming forward who want to do it, and by the way, I am sure that is true,” New York Gov. Andrew Cuomo said at a press conference, referring to the Trump administration’s view. “It’s just the timeline doesn’t work. I don’t need ventilators in six months, and I don’t need ventilators in five months, four months or three months. And by the way, California is not going to need ventilators in six months. It is now.”

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©2020 McClatchy Washington Bur

YOU CAN'T SHOOT A VIRUS
Neither hurricanes nor 9/11 caused as big a surge in gun sales as coronavirus

By Linda Robertson, Miami Herald 3/25/2020

© Elaine Thompson/AP Photo Rifles line a wall above in front of people standing in a gun shop Wednesday, Dec. 19, 2012, in Seattle. The reaction to the Connecticut school shooting can be seen in gun stores and self-defense retailers across the nation: Anxious parents are fueling sales of armored backpacks for children while firearms enthusiasts are stocking up on assault rifles in anticipation of tighter gun control measures.

MIAMI — Gun shop owners have never seen such a surge in sales — not after the 9/11 terrorist attacks, not in reaction to mass shootings, not even when Category 5 hurricanes threatened to flatten South Florida.

Fear and uncertainty about the impact of the coronavirus pandemic are motivating people to buy guns and ammunition as they seek protection from possible doomsday disintegration into lawlessness, with home invasions, looting, runs on banks, and fights over food, medicine, hospital beds and shelter across the land.

“Our sales are up 80 percent, with a huge increase in first-time buyers who are worried about martial law, economic collapse, unemployment, shortages, delinquents roaming the streets,” said Alex Elenberg, manager of Charlie’s Armory on West Flagler Street. “If you can’t defend your house and your family, what good are you?”

The United States is the home of the world’s largest gun-owning population per capita, where 40% of Americans say they own a gun or live in a household with guns. Even so, concern about the accelerating spread of COVID-19 is causing a spike in sales, according to sellers and data from gun-tracking agencies, such as the FBI’s National Instant Crime Background Check System, which saw a doubling of checks on applicant buyers last week.

In Florida, the number of background checks posted by the Florida Department of Law Enforcement, which closely correlates with the number of gun sales statewide, has risen to unprecedented levels, up nearly 500% on Friday alone, with 13,192 checks recorded compared to 2,646 on the same date last year.

From St. Patrick’s Day on March 17 through Saturday, 56,677 checks were recorded compared to 11,842 during the same five-day period in 2019. While the volume of checks in the FDLE’s Firearm Purchase Program decreased 16% in 2019, it’s up 38% in 2020, with a week to go in March.

“I think it’s a little too knee-jerk on the part of consumers, just like the toilet paper hoarding,” said Jorge Corbato, owner of Nebulous Ordnance Defense in Miami. “Do you really believe this virus is apocalyptic?”

Guns provide tangible comfort in a time of desperation, Corbato said. It’s like people are arming themselves against helplessness.

“Look, to me, a gun is a tool like a fire extinguisher. I’d rather have it than not,” he said. “It gives you a sense of security if the world goes south, sideways, or very bad.”

Corbato, a sportsman and former member of the U.S. Rifle Team, runs a small business with regular customers. For novices coming in over the past week, he has recommended Glock handguns, which he describes as “reliable, in the $500 range,” or, better yet for home protection, a shotgun like the Remington 870, for $300.

“It’s less cumbersome and it’s like a Chevrolet — low-tech, pump-action, doesn’t break,” he said. “In case of an intruder, if they even hear the sound of the gun racking, they’ll run. But remember, these scenarios don’t play out 99.9% of the time.

“I’m not trying to scare anybody during coronavirus. I will never convince anybody to buy a gun. It’s a big responsibility, owning a firearm. I don’t relate to the gun nuts or the ‘take it from my cold, dead hands’ philosophy. My customers are level-headed, and if I see someone who is too weird, I won’t sell to them.”

Like many other sellers, Samuel Rivera is running out of inventory at his Gunaholic shop in Hialeah. With sales up 60 percent, his stock of 100 handguns is down to 18. He placed four orders last week but his sold-out distributors don’t know when they’ll be able to replenish.

He’s selling to more women and senior citizens than usual, and is also doing brisk business in tasers, pepper spray and bulletproof vests. He refuses to price gouge, although he’s seen other stores raise prices — charging $25 for a 50-round box of 9 mm bullets that should cost half that.

“The women and the elderly are tired of being victims, and afraid of getting robbed at the ATM or scammed at home,” Rivera said. “I’m not worried about violence and I try to calm all my customers down. I tell them, it’s not like Venezuela. Fighting over toilet paper and Purell — that’s silly panic.”

Charlie Berrane, owner of Charlie’s Armory and the Warrior Gun Range and Gun Shop, said customers want to be prepared for mayhem.

“We don’t know where the virus will lead and we don’t know if we’ll be able to depend on our law enforcement officers to respond,” Berrane said Tuesday, monitoring the line outside his Doral store. “People want to be more self-reliant.”

Only three handguns were left in the display cases at Charlie’s Armory on Monday evening, and some ammo shelves were empty.

Elenberg said soaring sales also followed the school shootings at Sandy Hook Elementary in 2012 and at Marjory Stoneman Douglas High in Parkland in 2018, but those were mostly to existing gun owners who wanted to stock up in anticipation of new gun-control laws that might restrict ownership. Some current buyers are anxious about the federal government invoking emergency powers and halting gun purchases.

“We’ve been pushing Glocks and shotguns that are manageable, but ammunition is getting low, very low,” Elenberg said. “Manufacturers can’t keep up. Delivery services are overwhelmed. There are massive flaws in the supply chain right now.”

Gun stores are allowed to stay open in South Florida despite orders by local mayors for closures of nonessential businesses because state orders preempt them. Gov. Ron DeSantis said that firearm and ammunition supply stores can remain open.

Elenberg, Corbato and Rivera offer training classes and shooting range practice options but worry that the flood of new gun owners may not be receiving proper instruction because people are staying home.

At Brady: United Against Gun Violence, the organization behind the Brady Law that mandated a five-day waiting period on handgun purchases, President Kris Brown has issued a safety warning: New guns in new hands could add to the trauma of the pandemic.

“The unintended consequence of these panic-induced purchases in response to COVID-19 could be a tragic increase of preventable gun deaths for the loved ones these individuals are trying to protect,” Brown said. “While it is understandable to seek what can feel like protection in times of upheaval, we must acknowledge the risks that bringing guns into the home pose and take all appropriate measures to mitigate that risk.”

Unsecured firearms in homes can lead to unintentional shootings, what Brady calls “Family Fire,” shootings that injure or kill an average of eight children or teens every day. Improperly stored, unlocked guns at home increase the risk of death in a domestic violence incident by up to 500% and double the likelihood of a fatal outcome in a suicide attempt. Three quarters of all school shootings are by kids who have access to unsupervised guns at home.

Brown urged gun owners to lock unloaded guns in a safe and store ammunition separately, citing a University of Washington study of gun owners who had attended gun safety events and received free locking devices. Nevertheless, 40% of participants did not lock their guns at home, and 15% said their guns were loaded and unlocked at home, even when kids were around.

The Giffords Law Center Against Gun Violence, which lobbies for more restrictive background checks on every gun purchase, including those from private, unlicensed dealers, stressed that access to guns compounds the danger of domestic violence and suicide during times of crisis and economic hardship.

“Risks increase when protected parties are isolated, have limited access to legal remedies, and when safety planning, shelters, and counseling resources become unavailable,” the Giffords Center said in statement. “Many people may be experiencing increased anxiety and depression during this time. Data shows that when a person is experiencing a mental health crisis, easy access to guns significantly increases the risk of death by suicide.”

The National Shooting Sports Foundation, trade association for the firearms industry, emphasizes using the cable lock that comes with every new gun, pointing a firearm in a safe direction, keeping your finger off the trigger until you are ready to shoot, treating every gun as if it is loaded and knowing your target and what’s around and beyond it.

“During this stressful time and with children spending more time at home, protection includes making sure your firearms are stored securely,” said Joe Bartozzi, foundation president and CEO. “The last thing any firearm owner wants is to have their gun fall into the wrong hands, particularly those of a child or someone at risk of harming themselves.”

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©2020 Miami Herald

SEE

https://plawiuk.blogspot.com/2020/03/coronavirus-prompts-run-on-guns-in-us.html


https://plawiuk.blogspot.com/2020/03/you-cannot-kill-covid-19-with-gun-are.html

Trump team failed to follow NSC’s pandemic playbook

By Dan Diamond and Nahal Toosi 3/25/2020

The Trump administration, state officials and even individual hospital workers are now racing against each other to get the necessary masks, gloves and other safety equipment to fight coronavirus — a scramble that hospitals and doctors say has come too late and left them at risk. But according to a previously unrevealed White House playbook, the government should’ve begun a federal-wide effort to procure that personal protective equipment at least two months ago.

“Is there sufficient personal protective equipment for healthcare workers who are providing medical care?” the playbook instructs its readers, as one early decision that officials should address when facing a potential pandemic. “If YES: What are the triggers to signal exhaustion of supplies? Are additional supplies available? If NO: Should the Strategic National Stockpile release PPE to states?”

The strategies are among hundreds of tactics and key policy decisions laid out in a 69-page National Security Council playbook on fighting pandemics, which POLITICO is detailing for the first time. Other recommendations include that the government move swiftly to fully detect potential outbreaks, secure supplemental funding and consider invoking the Defense Production Act — all steps in which the Trump administration lagged behind the timeline laid out in the playbook.

© Chip Somodevilla/Getty Images Tom Bossert, who was formerly Trump’s homeland security adviser, expressed enthusiasm about the playbook's potential as part of the administration’s broader strategy to fight pandemics, two former officials said.

“Each section of this playbook includes specific questions that should be asked and decisions that should be made at multiple levels” within the national security apparatus, the playbook urges, repeatedly advising officials to question the numbers on viral spread, ensure appropriate diagnostic capacity and check on the U.S. stockpile of emergency resources.

The playbook also stresses the significant responsibility facing the White House to contain risks of potential pandemics, a stark contrast with the Trump administration’s delays in deploying an all-of-government response and President Donald Trump's recent signals that he might roll back public health recommendations.

“The U.S. government will use all powers at its disposal to prevent, slow or mitigate the spread of an emerging infectious disease threat,” according to the playbook’s built-in “assumptions” about fighting future threats. “The American public will look to the U.S. government for action when multi-state or other significant events occur.”

The guide further calls for a “unified message” on the federal response, in order to best manage the American public's questions and concerns. “Early coordination of risk communications through a single federal spokesperson is critical,” the playbook urges. However, the U.S. response to coronavirus has featured a rotating cast of spokespeople and conflicting messages; Trump already is discussing loosening government recommendations on coronavirus in order to “open” the economy by Easter, despite the objections of public health advisers.

The NSC devised the guide — officially called the Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents, but known colloquially as “the pandemic playbook” — across 2016. The project was driven by career civil servants as well as political appointees, aware that global leaders had initially fumbled their response to the 2014-2015 spread of Ebola and wanting to be sure that the next response to an epidemic was better handled.

The Trump administration was briefed on the playbook’s existence in 2017, said four former officials, but two cautioned that it never went through a full, National Security Council-led interagency process to be approved as Trump administration strategy. Tom Bossert, who was then Trump’s homeland security adviser, expressed enthusiasm about its potential as part of the administration’s broader strategy to fight pandemics, two former officials said.

Bossert declined to comment on any particular document, but told POLITICO that “I engaged actively with my outgoing counterpart and took seriously their transition materials and recommendations on pandemic preparedness.”

The playbook was designed “so there wasn’t piecemeal thinking when trying to fight the next public health battle,” said one former official who contributed to the playbook, warning that “the fog of war” can lead to gaps in strategies.

“These are recommended discussions to be having on all levels, to ensure that there’s a structure to make decisions in real-time,” said a second former official.

An NSC official confirmed the existence of the playbook but dismissed its value. “We are aware of the document, although it’s quite dated and has been superseded by strategic and operational biodefense policies published since,” the official said. “The plan we are executing now is a better fit, more detailed, and applies the relevant lessons learned from the playbook and the most recent Ebola epidemic in the [Democratic Republic of the Congo] to COVID-19.”

A health department spokesperson also said that the NSC playbook was not part of the current coronavirus strategy. “The HHS COVID-19 response was informed by more recent plans such as the foundation of the National Biodefense Strategy (2018), Biological Incident Annex (2017),and panCAP (2018) among other key plans provided by the CDC, White House Task Force, FEMA, and other key federal departments and agencies,” the spokesperson said.

Trump has claimed that his administration could not have foreseen the coronavirus pandemic, which has spread to all 50 states and more than 180 nations, sickening more than 460,000 people around the world. “Nobody ever expected a thing like this,” Trump said in a Fox News interview on Tuesday.

But Trump’s aides were told to expect a potential pandemic, ranging from a tabletop exercise that the outgoing Obama administration prepared for the president’s incoming aides to a “Crimson Contagion” scenario that health officials undertook just last year and modeled out potential risks of a global infectious disease threat. Trump’s deputies also have said that their coronavirus response relies on a federal playbook, specifically referring to a strategy laid out by the Centers for Disease Control.

It is not clear if the administration’s failure to follow the NSC playbook was the result of an oversight or a deliberate decision to follow a different course.

The document rested with NSC officials who dealt with medical preparedness and biodefense in the global health security directorate, which the Trump administration disbanded in 2018, four former officials said. The document was originally overseen by Beth Cameron, a former civil servant who led the directorate before leaving the White House in March 2017. Cameron confirmed to POLITICO that the directorate created a playbook for NSC staff intended to help officials confront a range of potential biological threats.

But under the Trump administration, “it just sat as a document that people worked on that was thrown onto a shelf,” said one former U.S. official, who served in both the Obama and Trump administrations. “It’s hard to tell how much senior leaders at agencies were even aware that this existed” or thought it was just another layer of unnecessary bureaucracy.

The NSC playbook would have been especially useful in helping to drive the administration’s response to coronavirus, given that it was intended to guide urgent decisions and coordinate the all-of-government approach that Trump so far has struggled to muster, said people familiar with the document.

The color-coded playbook contains different sections based on the relative risk — green for normal operations, yellow for elevated threat, orange for credible threat and red once a public health emergency is declared — and details the potential roles of dozens of departments and agencies, from key players like the Health and Human Services department to the Department of Transportation and the FBI. It also includes sample documents intended to be used at coordinating meetings.

“While each emerging infectious disease threat will present itself in a unique way, a consistent, capabilities-based approach to addressing these threats will allow for faster decisions with more targeted expert subject matter input from federal departments and agencies,” the playbook reads.

The playbook lays out different strategies for policymakers based on the severity of the crisis and shares lessons gleaned from past outbreaks. For instance, one section is devoted to addressing 34 “key questions” and 21 “key decisions” as soon as there is a “credible threat” — which in the case of coronavirus would have been early-to-mid January, as it raged in China and as the first U.S. case was detected on Jan. 20 — and calls on officials to move quickly.

“We recommend early budget and financial analysis of various response scenarios and an early decision to request supplemental funding from Congress, if needed,” the guide urges. But the Trump administration waited more than a month to ask for emergency funding after the timeline laid out in the playbook.

The playbook also repeatedly urges officials to question official numbers about the viral spread. “What is our level of confidence on the case detection rate?” reads one question. “Is diagnostic capacity keeping up?” But across January and much of February, Trump administration officials publicly insisted that their diagnostic efforts were sufficient to detect coronavirus. Officials now privately concede that the administration’s well-documented testing problems have contributed to the outbreak’s silent spread across the United States, and health experts say that diagnostic capacity is only now in late March catching up to the need.

In a subsequent section, the playbook details steps to take if there’s evidence that the virus is spreading among humans, which the World Health Organization concluded by Jan. 22, or the U.S. government declared a public health emergency, which HHS Secretary Alex Azar did on Jan. 31.

Under that timeline, the federal government by late January should have been taking a lead role in “coordination of workforce protection activities including… [personal protective equipment] determination, procurement and deployment.” Those efforts are only now getting underway, health workers and doctors say.

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'That's when all hell broke loose': Coronavirus patients overwhelm U.S. hospitals


By Michael Nedelman, CNN 3/25/2020

"We ended up getting our first positive patients -- and that's when all hell broke loose," said one New York City doctor.

© Michael Ciaglo/Getty Images DENVER, CO - MARCH 12: Healthcare workers from the Colorado Department of Public Health and Environment check in with people waiting to be tested for COVID-19 at the state's first drive-up testing center on March 12, 2020 in Denver, Colorado. The testing center is free and available to anyone who has a note from a doctor confirming they meet the criteria to be tested for the virus. (Photo by Michael Ciaglo/Getty Images)

The doctor, who spoke to CNN on condition of anonymity out of concern for his job, described a hospital that was woefully unprepared for an influx of Covid-19 patients that started roughly two weeks ago -- which has already stretched the hospital's resources thin and led to severely ill patients outnumbering ventilators.

"We don't have the machines, we don't have the beds," the doctor said.

"To think that we're in New York City and this is happening," he added. "It's like a Third World country type of scenario. It's mind-blowing."

At first, patients skewed toward the 70-plus age group, but in the past week or so there have been a number of patients younger than 50.

"I don't think they understand the severity of this disease," the doctor said of the younger patients.

"Two weeks ago, life was completely different."

Increasing capacity

Public health experts, including US Surgeon General Dr. Jerome Adams, have warned the US could "become Italy," where doctors in hospitals filled with Covid-19 patients have been forced to ration care and choose who gets a ventilator.

But the US may already be seeing the beginnings of this in some areas, marking a new stage of the nation's outbreak.

"The reality is that what we're seeing right now in our emergency rooms is dire," said Dr. Craig Spencer, director of global health in emergency medicine at NewYork-Presbyterian/Columbia University Medical Center in New York City.

"Last week when I went to work, we talked about the one or two patients amongst the dozens of others that might have been a Covid or coronavirus patient," Spencer told CNN's Anderson Cooper Tuesday. "In my shift yesterday, nearly every single patient that I took care of was coronavirus, and many of them extremely severe. Many were put on breathing tubes. Many decompensated quite quickly.

"There is a very different air this week than there was last week."

Officials in New York state are pushing hospitals across the state to increase capacity. The state is home to more than 6% of the world's confirmed cases so far -- and roughly half of all US cases.

In New York City, plans are also underway to build emergency hospitals and backfill other hospitals with 1,000 beds in the Javits Center, according to New York Gov. Andrew Cuomo. In addition, thousands of doctors and nurses, who are either retired or no longer see patients, have signed up as a "surge health care force," Cuomo said Wednesday.

There are simultaneous effort to procure ventilators for the most severe patients. According to Cuomo, New York has procured 7,000 ventilators in addition to 4,000 already on hand, and the White House said Tuesday that the state would receive two shipments of 2,000 machines this week from the national stockpile. But the state needs 30,000, Cuomo said.

The Strategic National Stockpile said Wednesday that it held approximately 16,660 ventilators before the coronavirus response, and ventilators have been deployed over the past few days.

"An outbreak, a pandemic like this could overwhelm any system in the world," warned Dr. Anthony Fauci, the United States' top infectious disease expert. Without enough ventilators, "that's when you're going to have to make some very tough decisions."

Cuomo also described the extreme measures hospitals are planning to take to increase their capacity for patients who need intensive care.

"We're going so far as to trying an experimental procedure where we split the ventilator," Cuomo said Tuesday. "We use one ventilator for two patients. It's difficult to perform, it's experimental, but at this point we have no alternative."

'Exceptionally chaotic'

It's not just New York that's feeling the pressure. Hospitals across the country are seeing a surge of patients, a shortage of personal protective equipment such as masks and gowns, and health care workers who feel that they, their families and their patients are being put at risk.

Several nurses around the country also spoke to CNN on condition of anonymity, also fearing they could lose their jobs.

One ER nurse in Virginia described her hospital as "exceptionally chaotic," with an emergency department where potential Covid-19 patients were sitting next to patients with other health conditions.

"You have an elderly couple that is having chest pain sitting right next to someone who has a cough and flu," she said. "I think that's extremely reckless."

She said she hadn't hugged her daughter since the outbreak started, for fear she may pass anything on to her.

Another nurse in Georgia said she was repeatedly denied testing, even as her own symptoms worsened over the course of a week. The nurse, who had cared for several patients who died of pneumonia but were never tested for Covid-19, was finally tested Tuesday -- the same day she was admitted to the hospital and put in isolation.

"It was not until this morning that I could finally be tested," she said as she gasped for breath between heavy coughs. "It is insane. And it's infuriating. You feel you have to scream to even be heard."

Judy Sheridan-Gonzalez, an ER nurse at Montefiore Medical Center and president of the New York State Nurses Association, said that "everybody is terrified" about becoming infected because many lack the proper protective gear, and many are being told to reuse the same mask between multiple patients.

Sheridan-Gonzalez said she fears not having enough ventilators or staff to take care of everyone, but it hasn't "hit that level yet" at her hospital.

Similarly, one New York City private hospital executive, who requested anonymity, told CNN that "many hospitals believe they are covered on ventilators. That doesn't mean some are not."

Still, the shortage of personal protective equipment continues to impact his and other hospitals.

For Sheridan-Gonzalez, the risk of becoming infected amid a shortage of masks and gowns is all too real.

"We feel an obligation to take care of our patients. Everybody does. But we don't want to become sick and we also don't want to become carriers," she said. "In my own hospital -- and I don't think it's unique -- we have a nurse who is on a ventilator right now who contracted the virus."

If the virus takes out health care workers, "it's game over. It's lights out," Dr. Peter Hotez, professor and dean of the National School of Tropical Medicine at Baylor College of Medicine, previously told CNN.

"If we have multiple frontline health care workers, ER physicians, nurses go down in this epidemic -- a situation where you have colleagues taking care of colleagues in the intensive care unit -- there's nothing more destabilizing for the United States."

Flattening the curve

The capacity of US health systems is at the core of the effort to "flatten the curve" -- to spread out the number of infections over time through measures such as social distancing.

The goal: to prevent hospitals from seeing a massive spike of patients arriving around the same time.

On Tuesday, President Donald Trump said he wanted the nation "opened up and just raring to go by Easter," which is April 12 -- a date that few health experts believe will be sufficient to contain the spread of coronavirus.

Earlier this month, Fauci said "it probably would be several weeks or maybe longer before we know whether we had an effect" on flattening the curve, and on Tuesday he emphasized the need to be "flexible" in the timeline Trump laid out.

"Obviously, no one is going to want to tone down things when you see things going on like in New York City," Fauci said Tuesday.

Some in New York don't foresee the outbreak abating anytime soon.

On Wednesday, Cuomo said he expects to see peak numbers of patients in approximately 21 days, based on current projections.

"We're really at the beginning of this outbreak," said NewYork-Presbyterian's Spencer. "And you can feel that. You can sense that. It's palpable on the front lines in the emergency department."

In a series of tweets early Tuesday, Spencer urged people to practice social distancing in order to save lives: "We were too late to stop this virus. Full stop. But we can slow it's spread.

"Hospitals are nearing capacity. We are running out of ventilators," he said. "Ambulance sirens don't stop."